White matter hyperintensity progression and late-life depression outcomes
White matter hyperintensity progression and late-life depression outcomes
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DOI：
10.1001/archpsyc.60.11.1090
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发表时间：
2003-11-01
影响因子：
--
通讯作者：
Krishnan, KRR
中科院分区：
文献类型：
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作者：
Taylor, WD;Steffens, DC;Krishnan, KRR
背景：白质高信号 (WMH) 是 T2 加权头颅磁共振成像 (MRI) 扫描中在大脑实质中看到的明亮病灶，与老年抑郁症相关。由于它们与年龄有关，因此它们的数量和大小会随着时间的推移而增加。据我们所知，这是第一个针对抑郁症 WMH 的纵向、体积 MRI 研究。 目的：确定 2 年内 WMH 进展是否会影响抑郁症结果。 设计：在 2 年多的时间里，抑郁症受试者根据自然躯体治疗算法接受抗抑郁治疗，旨在为个体提供最佳治疗。治疗期结束后，抑郁症受试者根据在此期间是否达到并持续缓解而被分为两类。 参与者： 133 名 60 岁或以上的受试者，符合 DSM-IV 重度抑郁症标准。 测量： 在基线时和大约 2 年后获得头颅 MRI。使用半自动分割过程测量每个半球的白质高信号体积。 结果：根据是否达到抑郁症状缓解（定义为蒙哥马利-阿斯伯格抑郁评定量表得分为 8 或更低）对受试者进行二分。 结果：实现并持续缓解的抑郁亚组的 WMH 体积增加 (11.5%) 显着低于未实现或维持缓解的组 (31.6%) （P=.01）。在回归模型中，WMH 体积的较大变化与未能维持缓解显着相关 (P=.004)，即使在控制基线抑郁严重程度、医疗疾病严重程度、年龄、性别和种族时也是如此。教育与实现和维持缓解相关（P=.02）。结论：WMH 量的较大进展与老年抑郁症的不良结局相关。未来的工作需要开发减缓 WMH 进展速度的方法，并确定这是否会改善老年人的抑郁症结果。
Context: White matter hyperintensities (WMHs) are bright foci seen in the parenchyma of the brain on T2-weighted cranial magnetic resonance imaging (MRI) scans and are associated with geriatric depression. Because they are associated with age, they should increase in number and size over time. To our knowledge, this is the first longitudinal, volumetric MRI study of WMHs in depression.Objective: To determine if WMH progression over 2 years influences depression outcomes.Design: Over 2 years, depressed subjects received antidepressant treatment according to a naturalistic somatic treatment algorithm designed to offer the best possible treatment to the individual. After the treatment period, depressed subjects were dichotomized based on whether they had reached and sustained remission during this period.Participants: One hundred thirty-three subjects aged 60 years or older meeting DSM-IV criteria for major depressive disorder.Measures: Cranial MRI was obtained at baseline and approximately 2 years later. White matter hyperintensity volume was measured in each hemisphere using a semiautomated segmentation process.Outcomes: Subjects were dichotomized based on achieving or not achieving remission of depressive symptoms, defined as a Montgomery-Asberg Depression Rating Scale score of 8 or less.Results: The depressed subgroup that achieved and sustained remission had significantly less increases in WMH volume (11.5%) than did the group that did not achieve or sustain remission (31.6%) (P=.01). In a regression model, greater change in WMH volume was significantly associated with failure to sustain remission (P=.004) even when controlling for baseline depression severity, medical illness severity, age, sex, and race. Education was associated with achieving and sustaining remission (P=.02).Conclusions: Greater progression of WMH volume is associated with poor outcomes in geriatric depression. Future work is needed to develop means of slowing the rate of WMH progression and to determine whether this will lead to improved depression outcomes in elderly persons.